AAVSB - American Association of Veterinary State Boards Emergency and Critical Care Questions and Answers — Questions and Answers
Question 1: According to the RECOVER initiative guidelines for veterinary CPR, what is the recommended rate for chest compressions in both dogs and cats?
- 60-80 compressions per minute
- 100-120 compressions per minute (Correct answer)
- 140-160 compressions per minute
- As fast as possible
Correct answer: 100-120 compressions per minute
The RECOVER (Reassessment Campaign on Veterinary Resuscitation) guidelines recommend a standardized chest compression rate of 100-120 per minute for both dogs and cats, regardless of size, to maximize cardiac output and coronary perfusion.
Question 2: A 5-year-old Labrador Retriever presents after being hit by a car. The dog is tachycardic (180 bpm), has pale mucous membranes, weak femoral pulses, and a capillary refill time of >3 seconds. Which of the following is the most appropriate initial fluid resuscitation plan?
- Administer 5% dextrose in water at a maintenance rate.
- Administer a 5 mL/kg bolus of hypertonic saline followed by an isotonic crystalloid.
- Administer a one-quarter shock dose (approx. 20-25 mL/kg) of an isotonic crystalloid over 15 minutes and then reassess. (Correct answer)
- Immediately administer a full shock dose (90 mL/kg) of an isotonic crystalloid as quickly as possible.
Correct answer: Administer a one-quarter shock dose (approx. 20-25 mL/kg) of an isotonic crystalloid over 15 minutes and then reassess.
The dog is in hypovolemic shock. The standard approach is to administer a fraction (1/4 to 1/3) of the total shock dose (90 mL/kg for a dog) of an isotonic crystalloid fluid (like LRS or Plasmalyte-A) as a rapid bolus, and then reassess perfusion parameters before giving more. Administering the full shock dose without reassessment can lead to volume overload, and maintenance rates or dextrose are inappropriate for initial shock resuscitation.
Question 3: A 7-year-old cat is presented in severe respiratory distress, exhibiting open-mouth breathing, a neck-extended posture, and cyanosis. The cat is extremely stressed. Which of the following is the most appropriate first action?
- Immediately take thoracic radiographs to diagnose the cause.
- Place an intravenous catheter and draw blood for a complete blood count and chemistry panel.
- Perform a detailed oral examination to check for foreign bodies.
- Provide supplemental oxygen in a calm, minimally stressful manner (e.g., in an oxygen cage or via flow-by) and administer a light sedative if needed. (Correct answer)
Correct answer: Provide supplemental oxygen in a calm, minimally stressful manner (e.g., in an oxygen cage or via flow-by) and administer a light sedative if needed.
In a patient with severe respiratory distress, especially a cat, minimizing stress is paramount as it can lead to decompensation and death. The first and most critical step is to provide oxygen supplementation with minimal handling. Stressful procedures like radiography or venipuncture should be delayed until the patient is more stable.
Question 4: You are the triage nurse in a busy emergency clinic. Which of the following four patients should be evaluated by a veterinarian first?
- A 2-year-old cat with a minor skin laceration on its flank, still bright and alert.
- A 6-month-old puppy with a 12-hour history of vomiting but is currently quiet and resting.
- A 10-year-old Great Dane with a distended abdomen, who is pacing and retching non-productively. (Correct answer)
- A 4-year-old dog who is weight-bearing lame on its right hind limb after playing fetch.
Correct answer: A 10-year-old Great Dane with a distended abdomen, who is pacing and retching non-productively.
The Great Dane is presenting with classic signs of Gastric Dilatation-Volvulus (GDV), a life-threatening emergency that causes obstructive shock and can lead to death within hours. This condition requires immediate stabilization and surgical intervention, making it the highest priority among the choices. The other patients, while needing care, are in more stable conditions.
Question 5: A 4-year-old dog is presented for acute lethargy, vomiting, and ataxia. The owner suspects the dog may have licked up a puddle of antifreeze in the garage 12 hours ago. Which microscopic finding in the urine sediment would be most supportive of a diagnosis of ethylene glycol toxicity?
- Struvite crystals
- Calcium oxalate dihydrate crystals
- Calcium oxalate monohydrate crystals (Correct answer)
- Ammonium biurate crystals
Correct answer: Calcium oxalate monohydrate crystals
Ethylene glycol is metabolized to oxalic acid, which then binds with calcium to form calcium oxalate crystals that precipitate in the renal tubules, causing acute kidney injury. The picket-fence or dumbbell-shaped calcium oxalate monohydrate crystals are considered the most characteristic finding for this toxicity. While dihydrate crystals can be seen, monohydrate crystals are more specific.
Question 6: A large-breed dog presents with signs highly suggestive of Gastric Dilatation-Volvulus (GDV). Which of the following interventions is the most critical and immediate component of stabilization?
- Administering broad-spectrum antibiotics intravenously.
- Obtaining right lateral abdominal radiographs to confirm the diagnosis.
- Placing two large-bore intravenous catheters and starting aggressive fluid resuscitation. (Correct answer)
- Performing an electrocardiogram (ECG) to check for arrhythmias.
Correct answer: Placing two large-bore intravenous catheters and starting aggressive fluid resuscitation.
GDV causes severe obstructive shock due to compression of the caudal vena cava and portal vein. The most critical first step in stabilization is to treat this shock with aggressive intravenous fluid therapy, typically through two large-bore cephalic catheters. While gastric decompression, radiography, and ECG are all important, restoring circulating volume to vital organs is the highest priority to prevent cardiovascular collapse.
AAVSB - American Association of Veterinary State Boards Emergency and Critical Care Questions and Answers
According to the RECOVER initiative guidelines for veterinary CPR, what is the recommended rate for chest compressions in both dogs and cats?